home Calculators Erythema nodosum. How is erythema nodosum diagnosed? Treatment of other diseases starting with the letter - y

Erythema nodosum. How is erythema nodosum diagnosed? Treatment of other diseases starting with the letter - y

Dermatosis erythema nodosum, or erythema nodosum, is a disease characterized by damage to the skin vessels by an inflammatory process (vasculitis, angiitis) with the appearance of painful formations in the form of nodes in the subcutaneous fatty tissue and dermis.

The latter are usually localized along the anterior and anterolateral surfaces of the thighs and legs.

Causes of erythema nodosum

Prevalence

Erythema nodosum occurs in 5-45% of the population, especially common in at a young age. As a result of epidemiological studies, it has been established that in different regions the incidence rate differs significantly and largely depends on the predominance of a particular pathology characteristic of a particular area. However, complete statistics on the prevalence of this disease are insufficient. It is only known that in the UK, 2-4 cases are registered per 1000 population every year.

The name of the disease was proposed at the end of the 18th century, and its clinical symptoms described in detail in the second half of the 19th century. In subsequent years, some features of the clinical manifestations of erythema nodosum in many infectious processes with a chronic course were also described, various schemes treatment, but the specific etiological factor has not yet been identified, and the frequency of chronic forms remains quite high.

Differences in incidence between urban and rural populations and between genders adolescence not noted. However, after puberty, girls and women are affected 3-6 times more often than boys and men.

It is generally accepted that pathology develops mainly against the background of other diseases, of which sarcoidosis is the most common. Although people of any age are at risk of developing erythema nodosum, young people 20-30 years of age are more often affected. This is due to the fact that the maximum incidence of sarcoidosis occurs precisely in this age period. Often, after an X-ray examination of the chest organs, sarcoidosis was discovered in patients who presented with a clinical picture of erythema nodosum.

A higher incidence of erythema nodosum is observed in winter and spring. This may be due to the seasonal increase in the number colds caused by beta-hemolytic streptococcus group A. Isolated cases of familial lesions of erythema nodosum, especially children, have also been described, which is explained by the presence among family members of a constant source of the infectious pathogen (beta-hemolytic streptococcus group A).

Etiology

The connection with streptococcus and sensitization of the body to its antigen (streptolysin) is confirmed by an increased level of antibodies in the blood of patients, which are antistreptolysin-O (ASLO).

There are many diseases that cause erythema nodosum. In addition to sarcoidosis, these include tuberculosis, especially in childhood, chorea, acute and chronic infections(angina, pleuropneumonia, chronic tonsillitis, chlamydia, yersiniosis, measles), syphilis, various autoimmune diseases (systemic lupus erythematosus, rheumatoid arthritis, dermatomyositis, etc.).

However, the development of erythema nodosum against the background of these pathological conditions does not yet indicate that they are its cause, which is fully consistent with the Latin proverb:

“Posthocnonestpropterhoc” - after “this” does not mean because of “this”.

Many of the listed diseases are provoked by staphylococci, streptococci, viruses, including some types of herpes virus, as well as long-term use(for example, in an autoimmune disease) glucocorticoid drugs that promote infection. This fact has led to the assumption that infectious pathogens, especially streptococci and staphylococci, are the cause of erythema nodosum.

At the same time, the development of the process is often observed in diseases or conditions not associated with bacterial flora - hepatitis “B” and “C”, chronic active hepatitis, HIV infection, ulcerative colitis, intestinal diseases inflammatory in nature(colitis), Crohn's disease, arterial hypertension, peptic ulcer, chronic cardiovascular failure, pregnancy, antiphospholipid syndrome, blood diseases, smoke inhalation by firefighters, jellyfish burns and others.

In addition, erythema nodosum can develop immediately after taking a number of medications. In one of scientific works about 80 are given similar drugs various groups and classes - oral contraceptives, bromides, codeine, antidepressants, antibiotics, sulfonamides, nonspecific anti-inflammatory, antifungal, antiarrhythmic, cytostatic drugs and etc.

Depending on the etiological factor, the disease is defined as:

Primary, or idiopathic if primary pathological condition or causative factor not identified. The number of such cases ranges from 37 to 60%.
Secondary - when establishing an underlying disease or factor that can be considered the cause.

Predisposing factors include hypothermia, seasonality, the presence of chronic diseases, malignant or benign neoplasms, venous and/or lymphatic insufficiency of the vessels of the lower extremities, medications, metabolic disorders and many others.

Pathogenesis and pathomorphological picture

The body's immune response

With regard to the mechanisms of disease development, most authors give primary importance to the hypothesis of an immediate or delayed immune reaction of the body in response to exposure to bacterial, viral or other provoking antigens. Quite often the development of the disease after taking certain medicines and the identity of the skin elements in erythema nodosum to rashes in allergic diseases confirms the assumption of the allergic nature of this pathology.

The skin is an area that quickly responds to the influence of a provoking agent. Under its influence, immune complexes are produced, which, circulating in the blood, settle and accumulate on the walls and around the walls of small vessels (venules) located in the connective tissue septa subcutaneous tissue.

These immune complexes activate B lymphocytes, which secrete antibodies. As a result, a hyperergic (excessive) reaction of local tissues occurs, which is characterized by inflammation, activation of vascular-active and thrombus-forming substances and necrosis. This reaction is accompanied by redness, sometimes itching, and the formation of an infiltrate (swelling, thickening). It is similar to the Arthus phenomenon - an immediate allergic reaction. It is not excluded allergic reaction delayed type, in which T cells are activated, and the disease follows the same type as contact dermatitis.

Hereditary predisposition

The hypothesis about hereditary predisposition. This is due to the high detection rate higher level TNF-alpha (tumor necrosis factor), high concentrations of IL-6 (interleukin) in the blood, which is not associated with the presence of an infectious disease, and a high incidence of HLA-B8 (human leukocyte antigen) in the blood in women with erythema nodosum.

It is assumed that when the process transitions to chronic stage Some infectious pathogens are included in the mechanisms of development of vasculitis and damage to the endothelial (inner) lining of blood vessels, which impart more pronounced aggressiveness to this process.

Pathomorphology

Pathological studies of materials obtained through skin biopsy indicate that the results depend on the stage of the pathological process. This reveals signs of damage characteristic of an excessive delayed-type allergic reaction. The inflammatory process in the walls of venules and arterioles is combined with their dilation (expansion), which causes the erythematous (reddish) color of the elements in the initial stages of the disease.

The interlobular connective tissue septa of adipose tissue, located at the border of the dermal layer and hypodermis, are thickened and have signs of fibrosis. They are penetrated to varying degrees by cells extending into the peri-septal zones. These cells, among which lymphocytes predominate, are involved in inflammatory processes. The skin inflammatory process and fibrosis of the septa explain the presence of characteristic dense nodules (granulomas).

At acute course Erythema nodosum, the main morphological changes are localized mainly in the subcutaneous fatty tissue, and in the dermal layer only nonspecific swelling around the vessels is detected. In subacute cases, along with inflammation of the walls of small subcutaneous vessels, infiltration of the interlobular septa is determined, in chronic (the most common form) - subcutaneous vasculitis (inflammation) of not only small but also medium vessels, as well as thickening of the wall and proliferation of cells in the inner lining of the capillaries of the interlobular septa.

Erythema nodosum and pregnancy

This disease during pregnancy, according to various sources, is diagnosed in 2-15% of women. It is believed that the same mechanisms underlie its development. Pregnancy is a unique state of a woman's body. It is possible only if there is a balance between nonspecific and specific types immunity. It is these factors that direct the immune response along a certain “channel”.

The restructuring of the endocrine and immune systems during gestation is a vulnerable link, which creates the conditions for the occurrence of erythema nodosum. Acute or activation of chronic infection during gestation against the background of physiological immunosuppression (suppression of immunity) to an even greater extent includes the mechanisms of the latter, which contributes to the sensitization of the vascular network of the dermis and hypodermis and leads to the threat of miscarriage.

How, in what period and with what to treat erythema nodosum during pregnancy is always difficult questions for doctors who must take into account Negative influence not only the disease itself, but also medications for the fetus. Antibiotics and antibacterial drugs have a particularly adverse effect during the formation of organs and systems of the unborn child (in the first trimester of pregnancy).

Thus, the main role in the etiology and pathogenesis of the disease is given to the body’s immune response to the influence of an infectious or non-infectious damaging agent. The role of the human body’s reactivity in this process, as well as all the links in the mechanisms of its interaction with aggressive agents, remain sufficiently unexplored.

The predominant localization of the pathological process on the legs is also not entirely clear, which is associated mainly with slow blood and lymph flow, with the structural features of muscle tissue and the vascular network of the lower extremities and with stagnation in them.

Symptoms of erythema nodosum

Depending on the severity, nature of the course and duration of the inflammatory process, the following forms of the disease are distinguished:

Spicy.
Migrating.
Chronic.

Acute erythema nodosum

It is a classic type, but not the most common variant of the course, the development of which is usually preceded by an acute infectious disease (tonsillitis, ARVI, etc.).

She is characteristic sudden appearance on the legs in the area of the front and side surfaces of the legs (sometimes - thighs) typical multiple elements in the form of subcutaneous nodes with a diameter of 5 to 60 mm or more, which can merge with each other, forming red plaques, and are never accompanied by itching. The occurrence of rashes is accompanied by pain of varying intensity, both at rest and when palpating them.

The nodes have a dense consistency and unclear outline (due to tissue swelling), slightly rise above the surrounding healthy skin surface. They quickly grow to a certain size, after which their growth stops. The skin located above them is smooth and red. Regression of granulomas can occur independently within 3 (in mild cases) or 6 (in more severe cases) weeks.

Their reverse development is never accompanied by the formation of ulcers and or. The nodes disappear without a trace, but sometimes peeling of the epidermis and/or hyperpigmentation may temporarily remain in their place.

Erythematous lesions are usually located symmetrically, but occasionally on one side, or are represented by single nodes. Very rarely, granulomas appear on the arms, neck and face, where they can merge with each other, forming erythematous (red) plaques, and sometimes extensive, merging lesions.

Localization of the process on the palmar and plantar (plantar) surfaces is usually one-sided and is more common in children, very rarely in adults. Plantar localization of erythema nodosum must be distinguished from the so-called plantar traumatic urticaria, which looks like areas of reddened skin on the soles. The latter occurs in children as a result of significant physical activity. Dynamic observation makes it easy to distinguish erythema nodosum from plantar erythema, in which the redness disappears within a few hours to 1 day.

Quite often the onset of the acute form of erythema nodosum is accompanied by high temperature body (up to 39°) and general subjective symptoms - weakness, malaise, headache, abdominal pain, nausea, vomiting and diarrhea, pain in joints and muscles. Approximately 32% of patients have symptoms of an inflammatory process in the joints - intra-articular effusion, the presence of skin hyperemia and tissue swelling in the joint area.

1. Plantar localization; 2. Localization of erythematous nodes on the legs

Migratory form

It occurs with similar clinical manifestations described above, but, as a rule, has an asymmetrical nature and a less severe inflammatory component. The disease begins with the appearance in a typical area (anterolateral surface of the leg) of one flat node of pasty consistency and cyanotic (bluish) color.

The node quickly grows due to its peripheral zones and transforms into a deep, large plaque with a sunken and pale central part. Its peripheral sections are surrounded by a richly colored ridge. The main node can be accompanied by single small nodes. The latter are often located on both legs. General symptoms are also possible - low fever, joint pain, general weakness and malaise. The duration of the migratory form ranges from several weeks to months.

Chronic form

Usually develops in women in middle and old age, more often against the background of cardiovascular disease (chronic heart failure, obliterating atherosclerosis and varicose veins of the lower extremities), allergic, infectious-inflammatory (adnexitis, etc.) or tumor pathology, for example, uterine fibroids.

This form of erythema nodosum is characterized by a long, persistent course. It occurs with relapses that occur in the spring and autumn periods and last for several months, during which the reverse development of some nodes occurs and the emergence of new ones.

There are usually several nodes, they are dense, have a diameter of about 40 mm, bluish-pink in color, are localized on the anterolateral surface of the leg, are accompanied by mild pain and moderate intermittent swelling of the leg and/or foot. On initial stage their appearance, the color of the skin may not change, and the granulomas themselves can only be determined by palpation. General symptoms may be mild or absent altogether.

Diagnostics

In making a diagnosis, the main role is played by external examination and careful collection of anamnesis (medical history). Anamnesis allows us to identify concomitant and/or previous diseases against which erythema nodosum developed and which may be its main cause.

A mandatory examination is radiography or, more reliably, CT scan chest organs. The presence in the study results of bilateral enlargement of intrathoracic lymph nodes in combination with erythema nodosum and elevated body temperature and in the absence of symptoms of pulmonary tuberculosis usually indicates Löfgren's syndrome. It often occurs in women during pregnancy and postpartum period. Löfgren's syndrome is one of the types mild course pulmonary sarcoidosis requiring appropriate therapy.

What tests need to be taken?

General blood tests are not very informative. They can only indicate (not always) the presence of an inflammatory (accelerated ESR) and/or allergic (increased number of eosinophils) process.

To some extent there are useful tests by determining antistreptolysin-O titers in two samples with an interval of 2-4 weeks. A change in titer of at least 30% indicates an inflammatory streptococcal infection in the recent past.

In particular difficult cases, as well as in case of resistance to treatment and persistent course of the disease, in order to carry out differential diagnosis, a biopsy of the affected area is performed, followed by histological examination (the histological picture is described above).

Treatment of erythema nodosum

If there is a pronounced picture of the disease, it is necessary to adhere to bed rest for a week, which helps reduce swelling of the lower extremities and the intensity of pain. In this case, it is recommended to give the legs an elevated position, and in case of severe symptoms, use elastic stockings or bandaging with elastic bandages.

Drug therapy

Local therapy

Local treatment is carried out with applications with Dimexin solution or Ichthyol solution, Dimexin gel in combination with Heparin, indovazin cream in combination with ointment or cream with corticosteroids - Beloderm containing betamethasone, Belogent (betamethasone with gentamicin), Belosalik (betamethasone with salicylic acid) .

After cupping acute manifestations In case of inflammation, it is possible to use physiotherapeutic procedures in the form of ozokerite applications, phonophoresis with liquid ointment (liniment) containing dibunol, with heparin, with lidase or hydrocortisone. Inductothermy, magnetic therapy, ultra-high frequency currents, laser treatment, etc. are also used.

Unified standards and treatment regimens for erythema nodosum have not been developed. The main drugs currently used are antibiotics. At the same time, their widespread use can contribute to the transition acute process into chronic. This is due to the lack of influence antibacterial agents and antibiotics for viruses and even many strains of bacteria. On modern stage treatment of both idiopathic and secondary disease, unfortunately, is aimed primarily at reducing the severity of local inflammatory processes and reducing the duration of the disease.

Damage to the subcutaneous and skin vessels and tissue, which provokes an inflammatory process, resulting in the appearance of dense hemispherical painful nodes, has a medical name - erythema nodosum. At the same time, the nodes are of allergic origin and can take on different shapes. The appearance of characteristic nodes can be observed in symmetrical areas.

Erythema nodosum - what is it?

Erythema nodosum can be classified as a type of allergic vasculitis. It can be distinguished from another variant of vasculitis by its location. It occurs only on the lower extremities.

All age groups are at risk of developing the disease. People aged 20-30 years are at risk. The peak incidence is observed in the autumn-winter period.

Before puberty, the disease is approximately equally common in women and men. Afterwards, morbidity rates in women increase 3-6 times.

Visually, the disease looks like uneven bumps on the skin. Besides the unattractive appearance, erythema gives the patient painful sensations when touched and pressed.

Erythema is considered a common disease. According to statistics, 30-40% of the population is exposed to it. When it appears, qualified medical assistance is needed.

Why does it occur

The cause and further development of erythema are various infectious processes occurring in the body. Less commonly, it can be provoked by drug sensitization.

Another reason for its appearance is concomitant sarcoidosis.

The disease occurs when:

Rarely, erythema can be observed with coccidioidomycosis, yersinosis, and inguinal lymphogranulomatosis.

Most dangerous drugs, provoking the disease:

At the first symptoms of erythema, other similar drugs with different active substance.

It is possible that the cause of the development of the disease is non-infectious in nature. Although they are quite rare in practice.

Non-infectious infections can occur in:

suffering ulcerative colitis;
patients with Behçet's disease;
patients with inflammatory bowel diseases;
people with oncological problems;
pregnant women;
suffering from vascular or allergic diseases.

There are cases of hereditary transmission of predisposition to erythema in patients with chronic forms of foci of infection, such as pyelonephritis, sinusitis, tonsillitis.

How the disease develops and progresses

Photos, symptoms and treatment of erythema nodosum prove that the disease should be taken seriously.

Before the disease develops, a prodromal cycle occurs. Its duration is 1-3 weeks.

The cycle is accompanied by a feverish state. A rash may appear sharply and suddenly on knee joints, ankles or shins.

If the rash spreads to the arms, thighs, face or neck, this may mean that the erythema has spread throughout the body.

The rash consists of nodes that can reach 5 cm in diameter. Initially they have a bright red tint, but darken over time. And in the end they turn blue - yellow color. resembling a passing bruise. This period of the disease is characterized running form diseases.

Each node can live from 1 week to several months. After the expiration date, it is destroyed. New nodes can form in 3-6 weeks.

Why is it dangerous?

The prognosis for erythema nodosum is comforting. The disease is not life-threatening, is highly treatable, and relapses are rare.

Erythema does not leave scars or any other aesthetically unattractive marks.

It should be remembered that the disease is concomitant. Therefore, all treatment efforts should be aimed at the underlying pathology.

To do this, it is necessary to undergo a thorough examination and identify the cause of the underlying disease.

Types of diseases and their features

There are 3 main types of erythema nodosum. The forms of its course depend on the nature of the disease and the degree of duration of the inflammatory processes occurring in the body.

Forms of the disease:

acute form - has pronounced initial symptoms. Nodes appear on the lower leg and have a swollen form. During the onset of the disease, body temperature may rise to 39 degrees. Symptoms: arthritis, general malaise, weakness, headaches. If the disease is provoked by streptococcal pharyngitis or tonsillitis, the disease can proceed without any complications and after 5-7 days, the nodes disappear without scars;
migrating or subacute - the inflammatory component is less pronounced than in the acute form. In this case, small nodules appear, located asymmetrically. If the disease does not go away within several months, the diagnosis is usually confirmed;
chronic - observed in elderly women prone to allergic reactions of the body, with tumor diseases or infectious processes. The peak of the disease occurs in autumn or spring. The nodes in this form become the size of a walnut and upon palpation cause the patient acute pain. The healing of old nodes occurs with the appearance of new ones.

To determine the stage of the disease, you need to know the main symptoms of the disease.

Symptoms

Each form of the disease is accompanied by its characteristic symptoms.

Characteristic symptoms of the acute form:

the temperature rises to 39 degrees;
joint and muscle pain occurs;
the appearance of SES and leukocytosis is observed.

The acute form progresses with general malaise and weakness.

The migratory form begins, as a rule, from one node. At first the node is flat and unitary, has restrictions from skin. Over time, it acquires a ring-shaped shape with a sunken middle.

Nodules can appear on both limbs simultaneously.

Symptoms of the migrating type:

body temperature 37.5 degrees. Can last for a long time;
chills;
allergy.

In addition, the state of general malaise may continue for several months.

The chronic form occurs with exacerbations in autumn and spring. The nodes are localized on the legs. They can only be detected by palpation. The form is protracted. With the destruction of old nodes, new ones appear. This process continues throughout the illness.

Diagnostics

The effectiveness of treatment of pathology directly depends on the correct diagnosis. When a patient approaches, the doctor can make a diagnosis based on the medical history, the patient’s complaints and objective examination.

To refute or confirm the accuracy of the diagnosis, the patient is sent to a series of instrumental and laboratory research.

Additional tests to make a diagnosis:

bacterial culture of stool and nasopharynx;
tuberculin diagnostics;
biopsy and examination of nodular neoplasms;
pharyngoscopy and rhinoscopy;
X-ray and computed tomography of the chest;
rheovasography of the lower extremities and ultrasound of the veins;
rheumatic tests and clinical analysis blood.

In addition, the doctor may prescribe additional consultation specialists: pulmonologist, phlebologist and otolaryngologist.

All studies are prescribed by a specialist at his discretion. Therefore, ordering all tests may not be necessary.

Treatment

Therapy for erythema nodosum is aimed at the complete elimination of vascular lesions and concomitant disease. The inflammatory process is stopped with the help of non-steroidal anti-inflammatory drugs.

Antibiotic desensitizing therapy is used. The fastest regression of symptoms is achieved by prescribing laser blood irradiation and extracorporeal hemocorrection methods.

To relieve pain, bandages with corticosteroid and anti-inflammatory ointments are used. Difficulties in treatment may arise during pregnancy.

Treatment becomes a little more complicated, since in this situation, not all medications are suitable for the expectant mother.

They begin to treat erythema with the prescription of non-steroidal drugs. If the symptoms occur with complications, the doctor uses antibiotics that have wide range actions.

For more effective and faster results, local and physical therapy is prescribed.

Auxiliary therapy using traditional methods

It is not uncommon for erythema nodosum of the lower extremities to be treated with folk remedies. Treatment methods traditional medicine become even more effective when combined with folk remedies. Folk recipes include herbs that have an anti-inflammatory effect and can also modulate immune system.

Possible complications

Treatment of erythema nodosum, both in adults and children, should be mandatory. Its main possible complication is its transition to the chronic stage.

Pathology gives those complications that are typical for any skin diseases.

Prevention

exception stressful situations;
regulating the time spent under straight lines sun rays;
avoiding interaction with allergens;
rational use of drugs;
setting optimal physical activity;
healthy eating;
sanitation of foci of infection.

Useful video: what is erythema nodosum

There are many cases where characteristic red rashes were found after suffering from a sore throat, taking certain antibiotics, sulfa drugs, contraceptives and iodine.

Doctors do not deny the influence of the hereditary factor. Chronic infections (tonsillitis, pyelonephritis, sinusitis) and diseases of allergic origin can also cause the development of this disease.

Erythema often affects people with diseased blood vessels.

It can also result from:

tuberculosis;
sarcoidosis;
leukemia;
lymphogranulomatosis;
streptococcal infection (scarlet fever, streptoderma);
venous diseases;
fungal infection;
rheumatoid arthritis;
lupus erythematosus;
nonspecific ulcerative colitis;
less often - cancer or leprosy.

Factors contributing to the development of the disease in pregnant women are disturbances in the functioning of the endocrine organs, blood stagnation in the lower extremities, prolonged exposure to cold, seasonal weather changes, and hypertension.

Causes

The disease can be either idiopathic, i.e. independent, or a consequence of previously suffered diseases. Causes of the disease:

There are studies that prove that erythema is nothing more than a variant of the course of vasculitis of an allergic nature. Many patients are interested in what it is. With this disease, local vascular damage occurs. As a rule, such damage occurs on the legs.

This diagnosis is made to people of any age category. The prevalence of this disease before the onset of puberty is almost the same in males and females. After puberty The disease is more common in women than in men.

Acute and chronic forms develop for the following reasons:

The main impetus for the development of acute erythema nodosum is respiratory, as well as acute viral disease. Many cases are marked by the appearance of spots with a rise in body temperature and poor health. The disease is characterized unpleasant sensations in the joints of the legs.

Erythema nodosum can be physiological and appear after various effects on the skin. The cause of erythema nodosum is massage, rubbing the skin with warming creams, as well as alcohol tinctures.

Sometimes illness erythema nodosum appears after acceptance medical supplies, however, there are cases of appearance after nervous, intense stress. The disease loves workaholics, who often experience nervous strain.

However, often the causes of acute erythema nodosum are tuberculosis bacillus, coccal infection and yeast-like pathogens.

The main reasons for the progression of erythema nodosum in humans have not yet been precisely established. Scientists suggest that the hereditary factor plays an important role in the development of this pathology.

They also note that in some clinical situations, erythema nodosum is a nonspecific immunoinflammatory syndrome. Infectious and non-infectious causes can provoke the manifestation of pathology.

Non-infectious causes:

The term “erythema nodosum” was introduced in 1807 by Robert Willan, a British dermatologist. Research by scientists has proven that erythema nodosum is one of the variants of allergic vasculitis.

In most patients, local damage to the vessels of the lower extremities accompanies the course of various diseases. Sometimes erythema manifests itself as an independent pathology.

The main cause of the disease is different kinds infections. The most common pathogen is streptococcus.

Erythema nodosum accompanies:

give birth;
sore throat;
otitis;
acute pharyngitis;
rheumatoid arthritis;
streptoderma;
cystitis;
yersiniosis;
inguinal lymphogranulomatosis and others.

Doctors still cannot explain exactly why primary erythema nodosum develops in humans. And the majority is inclined to believe that heredity - genetic predisposition - is to blame for everything.

People with the following ailments are prone to a chronic course of the disease:

vascular diseases ( varicose veins veins, thrombophlebitis and atherosclerosis of the lower extremities);
allergic diseases ( bronchial asthma, dermatitis, hay fever);
chronic infectious diseases(tonsillitis, sinusitis and pyelonephritis).

Secondary erythema has various reasons, its development can be triggered by the following factors:

Classification of the disease and its symptoms

As already noted, erythema can be acute or chronic. The chronic type of the disease has two types:

migrating (with this form, dense nodes have blurred boundaries, they are usually bluish or red);
superficial nodular (the nodes in this disease are very large, and the appearance and development of such objects is accompanied by skin rashes, fever, pain and an increase in the erythrocyte sedimentation rate).

This is the most common classification of the disease and is used most often. Idiopathic erythema is spoken of when its cause cannot be determined.

Symptoms of the disease

The disease is caused by the appearance of a hyperergic reaction to medicinal and bacterial allergens. And the main places where the rashes are concentrated are the front and side surfaces of the lower leg.

The condition of a patient with erythema nodosum is aggravated by chronic diseases. These are dental diseases, tonsillitis, tuberculosis, otitis media, and other viral infections.

Erythema nodosum falls under the category of independent disease when it is difficult to find out the cause.

Characteristic signs of vascular pathology:

How does a sick person feel? The main symptoms of this disease:

bad feeling;
weakness;
chills;
fever.

Nodular seals form on the second or third day after the patient begins to feel unwell. As a rule, the area of distribution of nodes is the anterior and lateral surface of the lower leg.

But there are cases when erythema nodosum is observed not only in the lower regions of the legs, but also on the thighs, arms, and forearms. Almost always, dense nodules are located symmetrically.

Diagnostics

Basic diagnostic methods for suspected erythema nodosum:

blood analysis;
bacteriological culture;
nodule biopsy;
CT scan;
rheovasography;
Doppler ultrasound examination venous vessels lower extremities.

Most informative histological examination. With its help, it can be established that the inflammatory reaction is localized in the subcutaneous tissue and in the lower layers of the dermis. Necrosis and tissue abscess are not diagnosed.

Differential diagnosis is very important, as it allows you to more accurately determine the presence of erythema. It makes it possible to identify the causes of erythema and outline possible ways treatment. The diagnosis can be made only after conducting a set of necessary studies.

There are the following methods for diagnosing the disease:

Culture for bacteria from the nasopharynx area. Usually it allows you to determine whether the patient has streptococci.
Diagnostics are carried out to exclude the presence of tuberculosis infection in a person.
A blood test for rheumatoid factors can establish or exclude the presence of rheumatic joint disease.
A node biopsy is usually prescribed difficult situations making diagnosis difficult.
Consultation with specialized specialists such as a pulmonologist, infectious disease specialist, phlebologist, vascular surgeon and so on.
Rhinoscopy.
Pharyngoscopy.
Ultrasound of the veins of the lower extremities.
X-ray examination of the lungs.

Such a thorough diagnosis allows you to determine treatment in adults and children. You should not refuse all necessary examinations, since recovery depends on them.

Diagnostics includes laboratory and instrumental examination methods:

Choose correct view therapy is difficult. Nodular rashes of various sizes are symptoms of many pathological processes in the body.

Diagnosis is quite specific. Tests are required to exclude or confirm the presence of underlying diseases. The list of “suspects” is wide – from tuberculosis to otitis media.

Mandatory studies:

bacterial culture from the nasopharynx;
blood test for rheumatoid factor;
tuberculin diagnostics;
pharyngoscopy;
computed tomography of the lungs;
a detailed blood test to determine the level of SES;
stool culture;
rhinoscopy;
X-ray of the lungs;
Doppler ultrasound of the veins of the lower extremities.

The unknown origin of the formations requires a biopsy of the nodes. Histology reveals the degree of development of the inflammatory process.

The effectiveness of therapy depends on the results of treatment of the cause of the inflammatory process, elimination accompanying pathologies. Good results are achieved by combining:

medicines;
physiotherapy methods;
traditional medicine recipes.

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If erythema nodosum appears, who treats this disease? First of all, you need to contact a dermatologist, because this is a skin pathology.

Although the signs of erythema nodosum are obvious, the doctor will always prescribe additional tests, such as:

Blood analysis.
Bacteriological culture.
Biopsy of the contents of the nodules.
Examination under a microscope.

If necessary, the patient may be referred for Doppler ultrasound of the vessels of the legs. To find out the cause of the disease, consultations with other specialists will be needed.

Differential diagnosis is a diagnosis that, based on facts or symptoms, excludes diseases and, in the end, leads to the formulation of a single correct diagnosis.

Erythema nodosum can be confused with the following diseases:

Thrombophlebitis. In this case, the disease also forms compactions that are painful when pressed, but they are localized along the veins and have a tortuous appearance. The patient complains of muscle pain, legs swell. If the blood clot becomes infected, then intoxication of the body occurs - the patient suffers from weakness and high fever.
Erysipelas or erysipelas is an acute infectious disease caused by streptococcus. There is a sharp rise in temperature to 38–39 °C and weakness. Then burning and pain in the affected areas, which swell over time. The area of redness has jagged edges and rises above healthy skin, hot and dense to the touch. Sometimes bubbles form that are filled with liquid. Unlike erythema nodosum, erysipelas is characterized by inflammation of the lymphatic vessels and nodes.
Erythema of Bazin or indurative tuberculosis. Rashes form on the back of the lower leg. Nodes form slowly. They do not become inflamed and do not rise above healthy areas. The skin over them has a blue-red color, which does not tend to change. However, the nodes can turn into ulcers and leave behind scars.
Christian-Weber disease. Characterized by inflammatory processes in subcutaneous fat tissue. Small subcutaneous lumps form on the forearms, thighs and torso, which are moderately painful when pressed.

Erythema nodosum always requires diagnosis to be confirmed. The first thing you need to do is a blood test, which determines the increased number of leukocytes and ESR.

If a bacteriological culture is carried out from the nasopharynx, a streptococcal infection is often isolated. If articular syndrome is present, then this is a reason to go to a rheumatologist.

If according to clinical signs It is not possible to make a diagnosis, then a biopsy of one of the nodules on the legs has to be performed. In order to understand what caused the disease, consultation with many specialists and studies such as:

Rhinoscopy.
Pharyngoscopy.
X-ray of the lungs.
Rheovasography.
Ultrasound scanning of the leg veins.

Once the cause of the disease has been identified, treatment can begin.

Treatment of the disease

Therapy for erythema involves treating the underlying cause of the disease. Treatment of erythema nodosum is based on the use of combination therapy.

Patients have their workload reduced lower limbs and recommend bed rest. Salicylates (Askofen, Aspirin) are prescribed; antihistamines– Suprastin, Zyrtek, Diazolin, Telfast, Tavegil or Claritin.

The main principles of treatment for this disease are as follows:

Sanitation of chronic infectious foci.
Antibiotic treatment (carried out only after preliminary general diagnosis).
Prescription of non-steroidal anti-inflammatory drugs. The most commonly used are Nimesil or Indomethacin, Brufen.
Hormonal drugs. These include, for example, Prednisolone.
Hemocorrection.
Laser therapy.
Phonophoresis.
Treatment of affected joints (with hydrocortisone).

Such a disease is unlikely to allow a person to perform any physical types of work. The disease is usually treated in a hospital setting. Bed or semi-bed rest is recommended.

Many patients are interested in whether sports are allowed during or after recovery. After such an illness, you must exclude any sports activities and training for a period of one month.

Drug treatment for such a disease is quite serious, because the list of drugs prescribed for erythema is significant. The patient cannot prescribe such medications for himself; he must consult a doctor. Let us note the most common medications, in addition to those listed above:

desensitizing drugs (taken if the body has allergies);
acetylsalicylic acid preparations;
vitamin preparations (especially groups B, C);
Rutin, Askorutin;
angioprotectors;
anticoagulants (in particular, heparic acid).

Treatment using traditional methods

Sometimes treatment with folk remedies can be practiced. First of all, this treatment involves a certain diet. You need to add grains, beans, and greens to your diet. To combat edema, diuretics are prescribed.

It should be noted that they are not the only means of treating erythema nodosum, but only complement what the doctor prescribed. Of course, if you practice this type of therapy, it can only alleviate the condition, and not cure the person completely.

After visiting a doctor, the patient will be prescribed an x-ray of the lungs to rule out tuberculosis and sarcoidosis, and will be recommended to do a smear for streptococcus and a test for Yersinia. To exclude infections, various blood tests will be prescribed.

Treatment of erythema nodosum should only be carried out by a highly qualified specialist. If the doctor was able to determine which disease provoked the development of the pathology, then first of all, it is necessary to begin treating it.

If erythema nodosum has developed against the background of an infectious disease, then antiviral, antibacterial and antifungal drugs are prescribed.

For the primary form of pathology, the following drugs are prescribed:

antihistamines;
non-steroidal anti-inflammatory drugs;
aminoquinoline drugs;
corticosteroids.

For local treatment It is recommended to use anti-inflammatory ointments (including hormonal ones) and make compresses. Physiotherapy also has a good effect in treating the disease. Laser therapy, phonophoresis, magnetic therapy, and ultraviolet radiation are prescribed.

As complementary therapy You can use folk remedies, but only after agreeing with your doctor. Uncontrolled use may not only not help, but also aggravate the course of the disease.

Folk remedies for the treatment of erythema nodosum:

Long before the advent of medicine, nature made sure that man could, with the help of medicinal plants speed up recovery. Modern medicine does not refute the fact that treating erythema with folk remedies can give positive results.

However, before using them, it would be much wiser to first consult with your doctor.

Erythema nodosum treatment involves complex treatment. Therapy is carried out in the following areas:

Drug treatment.
Physiotherapeutic procedures.
Traditional medicine recipes.

Need to know. When selecting treatment tactics for a patient, the doctor must take into account that it should not only relieve the manifestations of the disease, but also eliminate provoking factors.

How to fight a disease with medications

Complex drug treatment involves the use of the following means:

If the pathology develops as a result of an existing inflammatory disease, then taking antibacterial drugs, for example, such as “Penicillin”, “Tetracycline”.

Advice. The pathology will recede faster if you also take Prednisolone along with antibiotics.

Ointments or creams that have anti-inflammatory properties and accelerate tissue repair are prescribed externally. If erythema nodosum appears in children, then you can use Vishnevsky ointment, “Acemin”.

Therapy with non-steroidal anti-inflammatory drugs - Ibuprofen is suitable.
To eliminate the allergic factor, taking antihistamines (Tavegil, Suprastin) is indicated.
If the disease is chronic nature, then treatment must be supplemented with aminoquinoline drugs, for example, such as Delagil or Plaquenil.
To restore blood vessels, taking angioprotectors (Trental, Escusan) is indicated.

The painful manifestations of the disease can be removed using laser irradiation and hemosorption.

Treatment with physiotherapeutic methods

A great addition to drug therapy will be physical therapy. The following procedures are prescribed to patients:

Magnetotherapy.
Phonophoresis with Hydrocortisone.

Laser treatment.
Diathermy.
Compress with ichthyol solution.

Treatment usually ends with the prescription of immunomodulatory agents and vitamin preparations.

Important. If erythema is detected in a woman during pregnancy, then all treatment should be strictly under the supervision of a doctor. You cannot prescribe medications for yourself.

Traditional medicine against erythema

When such a pathology appears, many people wonder how to treat erythema nodosum at home. We can recommend using the following recipes from traditional healers:

Treatment is prescribed and carried out by a specialist after identifying the exact cause of the disease:

To relieve general symptoms, antihistamines may be prescribed, as well as a number of pharmacological agents a number of salicylates. Depending on the tests and reasons, antibiotics are prescribed.
Skin lumps are treated with anti-inflammatory and hormonal ointments, which are prescribed by the doctor for each case individually.
Physiotherapeutic methods include phonophoresis, warming compresses, and UHF.

Girls are more susceptible to this disease than boys. Erythema nodosum is most often diagnosed in children over 6 years of age.

At the same time, the child becomes very whiny and capricious, complains of pain in the abdomen and joints, red spots of different sizes and very painful nodes form on his legs.

The limbs swell, the pain intensifies with movement.

Anti-inflammatory drugs Aspirin, Brufen, Indomethacin are used to treat children. Warming compresses with heparin or ichthyol ointment are placed on the area of the rash.

As for erythema in expectant mothers, it is absolutely safe for the fetus. But the woman’s health is at risk because the disease can cause complications in the heart. For the treatment of erythema nodosum during pregnancy, the following is prescribed:

lubricating the affected areas with Indovazin ointment, Deep-relief ointment;
minimum dosage of Paracetamol;
to reduce inflammation - Aspirin (in the smallest doses);
Curantil tablets;
in severe cases - Diclofenac injections;
Antibiotics may also be prescribed (usually macrolides or cephalosporins), but only in the 2nd trimester.

Important! If signs of erythema appear in a child or expectant mother, then making a diagnosis on your own, much less engaging in treatment (even with herbs), is strictly prohibited! This can lead to unpredictable consequences.

The patient should definitely reduce the load on her legs, but, of course, she should not lie in bed all day.

Complications and consequences

Absence proper therapy will provoke the chronic stage of the disease. You shouldn’t think that in a month or a month and a half “everything will go away on its own.” A full examination and treatment of manifestations of erythema is mandatory.

Do not forget that formations on the skin are a sign internal problems. Untreated background diseases over time they transform into a more dangerous form with serious consequences.

Preventive measures

Prevention of the disease, as a rule, comes down to timely consultation with a doctor if certain health problems arise. If there are foci of infection, their complete sanitation is necessary. It's important to lead healthy image life, alternate physical activity with rest.

This pathology does not pose a health hazard, because the nodes tend to resolve. But still, it must be treated in order to prevent the development of a chronic form.

People prone to the formation of erythema nodosum need to be attentive to their health and promptly contact specialists when the first symptoms of trouble appear.

Basic Rules:

monitor the condition of the vascular system;
take action at the first signs of varicose veins;
avoid contact with allergens;
undergo regular medical examinations;
treat chronic diseases.

Erythema nodosum on the legs - serious illness. Use the entire arsenal of remedies suggested by your doctor. At integrated approach The prognosis for treatment is favorable.

Taking care of nutrition

During treatment of erythema nodosum, special attention must be paid to diet. Firstly, exclude allergenic foods, and secondly, support the body’s defenses with the help of vitamins contained in healthy foods.

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Treatment of erythema nodosum

Causes of erythema nodosum

This is a polyetiological syndrome, which is found in the practice of many specialists and has two clinical forms: idiopathic and symptomatic.

Some researchers express an opinion about the viral origin of idiopathic erythema nodosum, others believe that this disease, especially in children, is an allergic manifestation in most cases of tuberculosis infection and is observed mainly in people who have had or are suffering from tuberculosis in its various manifestations. In most of these patients, the Mantoux reaction is sharply positive, with exudative phenomena, lymphangitis and general symptoms.

Acute erythema nodosum can develop during or after infectious diseases caused by:

The pathogenesis of erythema in such cases is not entirely clear - an allergic reaction, septic granuloma or a reaction to bacterial toxins. It is possible to develop erythema nodosum against the background of:

taking medications (sulfonamides, antibiotics, iodine preparations, oral contraceptives),
sarcoidosis,
Behçet's disease,
ulcerative colitis,
Löfgren's syndrome,
rheumatism,
vaccinations and the like.

There are familial cases of erythema nodosum associated with a hereditary predisposition to sensitization of the body by infectious or other agents.

Some researchers classify erythema nodosum as a deep vasculitis.

In 40% of cases causeoccurrence of erythema nodosum remains unknown.

The development of changes in the skin with erythema may be preceded by prodromal phenomena in the form of:

ailments,
increase in body temperature,
arthralgia,
myalgia,
catarrhal phenomena.

They are observed 3-5, less often 7-10 days before the appearance of nodes.

The clinic is characterized by the appearance on the front and lateral surfaces of the legs of painful, dense, acutely inflammatory (looks like erythema), bright red knots (from 2 to 50), the size of a pea to walnut, placed deep in the subcutaneous tissue focally and symmetrically. Sometimes they can merge, their contours are unclear, which is associated with swelling of the surrounding tissues. In some cases, nodes may appear on the back of the legs, forearms, thighs, buttocks, torso, and even more rarely on the feet, hands, and face. Sometimes a macular, papular, urticarial or hemorrhagic rash or a rash characteristic of erythema multiforme. After a few days, the nodes acquire a bluish, then yellow-green color, reminiscent of the color changes of a bruise, their pain decreases, and complete regression is observed after 2-3, less often 4-6 weeks, leaving temporary pigmentation. Specified clinical manifestations during the period of their occurrence, they are also accompanied by fever, a disturbance in the general condition, pain in the joints and bones. Some patients may have gastrointestinal disorders, neurological symptoms. Leukocytosis or leukopenia and accelerated ESR are observed in the blood.

Histological changes in the tissue of nodes can be of three types:

tuberculoid structure of the cellular inflammatory infiltrate in the subcutaneous tissue with giant Langerhans cells without caseous decay;
nested placement of cellular infiltrate with giant Langerhans cells without a clear tuberculoid structure;
nonspecific inflammatory changes in the subcutaneous tissue.

In addition, there is also chronic erythema nodosum, which is not accompanied by acute inflammatory phenomena; the nodes are mildly painful, remain unchanged for months and resolve without decay, leaving no lasting trace. In such patients, foci of focal infection are often detected.

It is believed that the clinical variants of erythema nodosum should also include migratory erythema nodosum, described by Beferstedt in 1954. In this case, the provoking factors are pregnancy (up to 40%), especially in the first trimester, in second place - streptococcal infections, on the third - sarcoidosis. The number of nodes is formed from 1 to 8, often asymmetrical placement, although a symmetrical version can also be observed. Nodes are susceptible to migration, recurrence, average duration The disease lasts 4-5 months and regresses without leaving a trace.

How to treat erythema nodosum?

Treatmenterythema nodosum must begin with identifying its cause, and it largely lies in eliminating this cause. However, this is not always possible. In cases where erythema nodosum is associated with infectious factors, antibiotics are indicated - depending on the nature of these factors, rifampicin, streptomycin, penicillin, tetracycline and the like. The drugs are taken in usual doses for 1-2 weeks. The effect is significantly enhanced when antibiotics are combined with small doses of corticosteroids - 15-20 mg of prednisolone once a day after breakfast. Systemic glucocorticoids in treatment of erythema nodosum effective, but they should be used as a last resort, since they usually affect the course of the underlying disease.

Anti-inflammatory drugs are also used - acetylsalicylic acid, indomethacin (methindol), butadione, ibuprofen and others. Potassium iodide is quite effective in daily doses of 300-900 mg for 2-4 weeks. In cases of a clear connection between exacerbations of erythema nodosum and menstruation, oral contraceptives are indicated for 3-6 cycles. The use of such drugs in medicinal purposes permissible after consultation with a gynecologist.

Of the physiotherapeutic methods, the following have a good effect on erythema nodosum:

UV in erythemal doses,
magnetotherapy,
laser therapy,
phonophoresis with hydrocortisone on the area of inflammatory nodes or affected joints.

What diseases can it be associated with?

Erythema nodosum is not so much an independent disease as a symptom of other disorders in the body. There are many points of view on the origin of erythema nodosum, the main ones are as follows:

against the background of infectious diseases caused by:
- streptococci, the manifestations of which are streptoderma, otitis media,
- viruses,
- rickettsia,
- salmonella,
- chlamydia,
- yersinia,
- Mycobacterium tuberculosis, etc.;
against the background of the production of bacterial toxins;
against the background of an allergic reaction;
a type of septic granuloma;
as a consequence of systemic diseases:
- Löfgren's syndrome,
against the background of inflammatory bowel diseases:
- ulcerative colitis,

Treatment of erythema nodosum at home

Treatment of erythema nodosum usually carried out on an outpatient basis, the patient is registered at a dispensary, periodically visits the doctor, undergoes an examination and clarifies the treatment strategy. In conditions medical institution Physiotherapeutic procedures may be performed, and hospitalization may also be possible in order to cure the underlying disease, the symptom of which is erythema nodosum (for example, tuberculosis).

What medications are used to treat erythema nodosum?

Antibiotics:

- 10 mg/kg 1 time per day or 15 mg/kg 2-3 times per week;
- dosage is individual, administered intramuscularly, intravenously, subcutaneously, endolumbarally;
- a single dose for adults is 250 mg every 6 hours.

Corticosteroids:

- 15-20 mg 1 time per day after breakfast.

Anti-inflammatory drugs:

- 0.5-1 g per day (maximum up to 3 g), can be used 3 times a day;
- 0.2-0.4 g during or after meals 3-4 times a day;
- the dosage is individual, depending on the underlying disease;
- 25 mg 2-3 times a day;
- daily dose 300-900 mg for 2-4 weeks.

Treatment of erythema nodosum with traditional methods

Conservative treatment of erythema nodosum can be supplemented by using folk remedies. The following are used for oral administration: medicinal herbs and berries like:

Any herb listed above in the amount of 1 tbsp. should be infused in ½ liter of boiling water and taken 1/3 cup before meals.

Compresses and ointments based on nettle, mistletoe, and arnica are used locally:

Grind 100 grams of dried arnica roots to a powder, combine with an equal amount of fresh pork fat and leave on low heat or in the oven for up to three hours; when the medicine has cooled, it will take the form of an ointment, which should then be used at night under gauze bandages;
Use freshly squeezed nettle juice for compresses, moistening the same gauze bandage in it.

Treatment of erythema nodosum during pregnancy

Erythema nodosum often develops in pregnant women, in such cases it is idiopathic in nature. The exception is chronic diseases present at the time of pregnancy.

The factors causing erythema in a pregnant woman are usually:

seasonal weather changes,
hypothermia of the body,
congestion in the lower extremities,
hypertensive changes,
restructuring of the endocrine-immune cascade.

An expectant mother should contact specialized specialists with a similar problem. Profile diagnostics and conservative treatment carried out exclusively under their control. The doctor will have a goal to reduce the severity of skin manifestations of the pathology and exclude the presence of infection and other serious reasons erythema.

bed rest,
non-steroidal anti-inflammatory drugs,
antibacterial drugs, preferably in the second trimester and provided that their use is inevitable, and the existing infection is obviously more destructive than the medicine being taken - these are the means penicillin series, cephalosporins and some macrolides.

WITH for preventive purposes applies:

sanitation of foci of focal infection,
treatment of concomitant diseases,
avoiding the use of drugs that provoke the disease.

Which doctors should you contact if you have erythema nodosum?

The diagnosis used for erythema nodosum is not specific; it is aimed at identifying the underlying cause of the erythema. The methods used make it possible to differentiate erythema from other dermatological disorders. A blood test reveals neutrophilic leukocytosis and increased ESR.

Bacterial culture of stool and nasopharyngeal smear is carried out, tuberculin diagnostics, and a blood test for rheumatoid factor are appropriate.

To confirm the analysis, the nodule is subjected to biopsy and histological examination for the presence of inflammation.

In the process of identifying the etiological factor, the patient may be referred for consultation to:

pulmonologist,
infectious disease specialist
otolaryngologist,
vascular surgeon
phlebologist.

Diagnostic methods that may be appropriate:

rhinoscopy,
pharyngoscopy,
CT scan,
radiography of the lungs,
rheovasography of the lower extremities.

Differential diagnosis of erythema nodosum is carried out with indurative erythema in cutaneous tuberculosis, migratory thrombophlebitis, panniculitis, nodular vasculitis formed in syphilis.

Erythema nodosum is also differentiated from the following rarer diseases:

FeverishChristian-Weber nodular panniculitis. It is characterized by the presence of single or multiple, somewhat painful nodes in the subcutaneous tissue, often located asymmetrically on the legs, thighs, arms, and torso. At first the nodes are dense, subsequently softer, the skin over them is at first somewhat hyperemic, and then late stage- not changed. The nodes appear in paroxysms at intervals of several days or months and resolve, leaving a saucer-shaped recess, hyper- or depigmentation on the skin, does not suppurate. The onset is subacute with fever, impaired general condition, joint pain; with relapses, the general condition may not be affected. The duration of the disease is years and decades. Women aged 30-40 years are most often affected. Similar changes can occur in the retroperitoneal, perirenal tissue, and omentum, which indicates the systemic nature of the damage to the fatty tissue. Histologically, pseudoxanthoma cells are detected.
SubacuteVilanova-Piñol migratory nodular hypodermatitis. Women are more likely to get sick; the rash often occurs after a sore throat or flu. Asymmetrically, a deep nodular infiltrate the size of a palm appears on the anterior surface of the leg, slightly painful on palpation, with clear contours and a chronic course. Histologically, it differs from erythema nodosum in that it affects not large vessels, but the capillaries of the subcutaneous tissue. Hypodermatitis nodosa can sometimes develop as a reaction to a tuberculosis infection.

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The information is for educational purposes only. Do not self-medicate; For all questions regarding the definition of the disease and methods of its treatment, consult your doctor. EUROLAB is not responsible for the consequences caused by the use of information posted on the portal.

This is a polyetiological syndrome that is found in the practice of many specialists and has two clinical forms: idiopathic and symptomatic.

Acute erythema nodosum can develop during or after infectious diseases caused by:

taking medications (sulfonamides, antibiotics, iodine preparations, oral contraceptives),
sarcoidosis,
Behçet's disease,
ulcerative colitis,
Löfgren's syndrome,
rheumatism,
vaccinations and the like.

There are familial cases of erythema nodosum associated with a hereditary predisposition to sensitization of the body by infectious or other agents.

Some researchers classify erythema nodosum as a deep vasculitis.

In 40% of cases causeoccurrence of erythema nodosum remains unknown.

The development of changes in the skin with erythema may be preceded by prodromal phenomena in the form of:

ailments,
increase in body temperature,
arthralgia,
myalgia,
catarrhal phenomena.

They are observed 3-5, less often 7-10 days before the appearance of nodes.

The clinic is characterized by the appearance on the front and lateral surfaces of the legs of painful, dense, acutely inflammatory (looking like erythema), bright red nodes (from 2 to 50), the size of a pea to a walnut, located deep in the subcutaneous tissue focally and symmetrically. Sometimes they can merge, their contours are unclear, which is associated with swelling of the surrounding tissues. In some cases, nodes may appear on the back of the legs, forearms, thighs, buttocks, torso, and even more rarely on the feet, hands, and face. Sometimes a macular, papular, urticarial or hemorrhagic rash or a rash characteristic of erythema multiforme may be observed next to the nodes. After a few days, the nodes acquire a bluish, then yellow-green color, reminiscent of the color changes of a bruise, their pain decreases, and complete regression is observed after 2-3, less often 4-6 weeks, leaving temporary pigmentation. These clinical manifestations during the period of their occurrence are also accompanied by fever, disturbances in general condition, pain in the joints and bones. Some patients may have gastrointestinal disorders and neurological symptoms. Leukocytosis or leukopenia and accelerated ESR are observed in the blood.

Histological changes in the tissue of nodes can be of three types:

tuberculoid structure of the cellular inflammatory infiltrate in the subcutaneous tissue with giant Langerhans cells without caseous decay;
nested placement of cellular infiltrate with giant Langerhans cells without a clear tuberculoid structure;
nonspecific inflammatory changes in the subcutaneous tissue.

It is believed that the clinical variants of erythema nodosum should also include migratory erythema nodosum, described by Beferstedt in 1954. In this case, the provoking factors are pregnancy (up to 40%), especially in the first trimester, streptococcal infections are in second place, and sarcoidosis is in third place. The number of nodes is formed from 1 to 8, often asymmetrical placement, although a symmetrical version can also be observed. The nodes are susceptible to migration and relapse, the average duration of the disease is 4-5 months, and they regress without leaving a trace.

How to treat erythema nodosum?

Anti-inflammatory drugs are also used - acetylsalicylic acid, indomethacin (methindol), butadione, ibuprofen and others. Potassium iodide is quite effective in daily doses of 300-900 mg for 2-4 weeks. In cases of a clear connection between exacerbations of erythema nodosum and menstruation, oral contraceptives are indicated for 3-6 cycles. The use of such drugs for medicinal purposes is permissible after consultation with a gynecologist.

Of the physiotherapeutic methods, the following have a good effect on erythema nodosum:

UV in erythemal doses,
magnetotherapy,
laser therapy,
phonophoresis with hydrocortisone on the area of inflammatory nodes or affected joints.

What diseases can it be associated with?

Erythema nodosum is not so much an independent disease as a symptom of other disorders in the body. There are many points of view on the origin of erythema nodosum, the main ones are as follows:

against the background of infectious diseases caused by:
- streptococci, the manifestations of which are streptoderma, otitis media,
- viruses,
- rickettsia,
- salmonella,
- chlamydia,
- yersinia,
- Mycobacterium tuberculosis, etc.;
against the background of the production of bacterial toxins;
against the background of an allergic reaction;
a type of septic granuloma;
as a consequence of systemic diseases:
- Löfgren's syndrome,
against the background of inflammatory bowel diseases:
- ulcerative colitis,

Treatment of erythema nodosum at home

Treatment of erythema nodosum usually carried out on an outpatient basis, the patient is registered at a dispensary, periodically visits the doctor, undergoes an examination and clarifies the treatment strategy. Physiotherapeutic procedures can be carried out in a medical facility, and hospitalization is also possible in order to cure the underlying disease, the symptom of which is erythema nodosum (for example, tuberculosis).

What medications are used to treat erythema nodosum?

Antibiotics:

- 10 mg/kg 1 time per day or 15 mg/kg 2-3 times per week;
- dosage is individual, administered intramuscularly, intravenously, subcutaneously, endolumbarally;
- a single dose for adults is 250 mg every 6 hours.

Corticosteroids:

- 15-20 mg 1 time per day after breakfast.

Anti-inflammatory drugs:

- 0.5-1 g per day (maximum up to 3 g), can be used 3 times a day;
- 0.2-0.4 g during or after meals 3-4 times a day;
- the dosage is individual, depending on the underlying disease;
- 25 mg 2-3 times a day;
- daily dose 300-900 mg for 2-4 weeks.

Treatment of erythema nodosum with traditional methods

Conservative treatment of erythema nodosum can be supplemented by the use of folk remedies. For oral administration, the following medicinal herbs and berries are used:

Any herb listed above in the amount of 1 tbsp. should be infused in ½ liter of boiling water and taken 1/3 cup before meals.

Compresses and ointments based on nettle, mistletoe, and arnica are used locally:

Grind 100 grams of dried arnica roots to a powder, combine with an equal amount of fresh pork fat and leave on low heat or in the oven for up to three hours; when the medicine has cooled, it will take the form of an ointment, which should then be used at night under gauze bandages;
Use freshly squeezed nettle juice for compresses, moistening the same gauze bandage in it.

Treatment of erythema nodosum during pregnancy

Erythema nodosum often develops in pregnant women, in such cases it is idiopathic in nature. The exception is chronic diseases present at the time of pregnancy.

The factors causing erythema in a pregnant woman are usually:

seasonal weather changes,
hypothermia of the body,
congestion in the lower extremities,
hypertensive changes,
restructuring of the endocrine-immune cascade.

An expectant mother should contact specialized specialists with a similar problem. Profile diagnostics and conservative treatment should be carried out exclusively under their supervision. The doctor will have a goal to reduce the severity of skin manifestations of the pathology and exclude the presence of infection and other serious causes of erythema.

bed rest,
non-steroidal anti-inflammatory drugs,
antibacterial drugs, preferably in the second trimester and provided that their use is inevitable, and the existing infection is obviously more destructive than the medicine being taken - these are penicillin drugs, cephalosporins and some macrolides.

For preventive purposes the following is used:

sanitation of foci of focal infection,
treatment of concomitant diseases,
avoiding the use of drugs that provoke the disease.

Which doctors should you contact if you have erythema nodosum?

Bacterial culture of stool and nasopharyngeal smear is carried out, tuberculin diagnostics, and a blood test for rheumatoid factor are appropriate.

To confirm the analysis, the nodule is subjected to biopsy and histological examination for the presence of inflammation.

In the process of identifying the etiological factor, the patient may be referred for consultation to:

pulmonologist,
infectious disease specialist
otolaryngologist,
vascular surgeon
phlebologist.

Diagnostic methods that may be appropriate:

rhinoscopy,
pharyngoscopy,
CT scan,
radiography of the lungs,
rheovasography of the lower extremities.

Differential diagnosis of erythema nodosum is carried out with indurative erythema in cutaneous tuberculosis, migratory thrombophlebitis, panniculitis, nodular vasculitis formed in syphilis.

Erythema nodosum is also differentiated from the following rarer diseases:

FeverishChristian-Weber nodular panniculitis. It is characterized by the presence of single or multiple, somewhat painful nodes in the subcutaneous tissue, often located asymmetrically on the legs, thighs, arms, and torso. At first the nodes are dense, subsequently softer, the skin over them is initially somewhat hyperemic, and at a later stage is not changed. The nodes appear in paroxysms at intervals of several days or months and resolve, leaving a saucer-shaped recess, hyper- or depigmentation on the skin, does not suppurate. The onset is subacute with fever, impaired general condition, joint pain; with relapses, the general condition may not be affected. The duration of the disease is years and decades. Women aged 30-40 years are most often affected. Similar changes can occur in the retroperitoneal, perirenal tissue, and omentum, which indicates the systemic nature of the damage to the fatty tissue. Histologically, pseudoxanthoma cells are detected.
SubacuteVilanova-Piñol migratory nodular hypodermatitis. Women are more likely to get sick; the rash often occurs after a sore throat or flu. Asymmetrically, a deep nodular infiltrate the size of a palm appears on the anterior surface of the leg, slightly painful on palpation, with clear contours and a chronic course. Histologically, it differs from erythema nodosum in that it affects not large vessels, but the capillaries of the subcutaneous tissue. Hypodermatitis nodosa can sometimes develop as a reaction to a tuberculosis infection.

Treatment of other diseases starting with the letter - y

Acne treatment

Treatment of kidney duplication

Treatment of polyarteritis nodosa

Treatment of nodular goiter

Treatment of ureaplasmosis

Treatment of ureterohydronephrosis

Treatment of urethritis